Chylothorax in a Level III Neonatal Intensive Care Unit: A Case Series Quilotórax numa Unidade de Cuidados Intensivos Neonatais de Nível III: Estudo de Série de Casos

Abstract

INTRODUCTION: Chylothorax is a rare potentially life-threatening condition characterized by accumulation of chyle in the pleural space. It can be responsible for metabolic, nutritional and immunological complications in newborn infants. Our aim was to evaluate the clinical course and treatment of all cases of neonatal chylothorax admitted to a Portuguese tertiary perinatal unit.

METHODS: Retrospective analysis of institutional records of newborn diagnosed with chylothorax between 1st of February 2007 and 31st of January 2017 in a tertiary neonatal intensive care unit.

RESULTS: Six patients were included; two cases were congenital, one with prenatal diagnosis. The remaining cases were all secondary to trauma during thoracic surgery. All needed ventilation support with high positive end-expiratory pressure. Except for two cases, parenteral nutrition was implemented at diagnosis. Three cases did not improve with conservative treatment. One case was effectively treated with octreotide. Two patients died, one due to shock and multiorgan failure and the other one due to respiratory failure.

DISCUSSION/CONCLUSION: In our sample, trauma (from thoracic surgery) was the main etiology, reflecting our Unit´s collaboration with the pediatric cardiology department. Concerning diagnosis and treatment there are some algorithms, however, there are no national or international accepted guidelines and there are some aspects of the therapeutic approach that remain controversial.